Models of the Physician-Patient Relationship

Tomas Jose Silber, MD
JAMA. 1992;268(11):1410-1411. doi:10.1001/jama.1992.03490110048018.
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To the Editor.  —Regarding the four models of the physician-patient relationship by Emanuel and Emanuel,1 I suggest that they need to be expanded and/or adapted to the special case of the physician-adolescent patient relationship.2-4 This is an important stage in life when abstract thought develops, the capacity for reflection grows, and the need to establish an identity (to which the development of a value system is essential) becomes first and foremost.3 What happens at the time of this "second period of individuation" will have a dramatic impact throughout adult life.4 Hence the importance of the interaction with parents, teachers, and physicians. For many teenagers, the physician-adolescent encounter may be the first time they experience being taken seriously "as persons."5 The deliberative model is a natural for adolescents.Moreover, the deliberative model especially needs to be used with teenagers at any physician encounter because they are


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